An Overview of High-Risk Pregnancy

A high-risk pregnancy is a pregnancy that has a greater chance of encountering problems before, during, or after delivery. It requires more careful monitoring than a typical pregnancy.

But, even though there is the potential for complications, with early and regular care a high-risk pregnancy can still be healthy and lead to a healthy delivery and baby. Here’s what you need to know about the care, testing, and monitoring of a high-risk pregnancy along with some tips to keep you and your baby as safe and healthy as possible.

Screening is a way to gather information to see if someone is at risk for a condition. Screening tests do not give a diagnosis, but they can help healthcare providers recognize who may have or develop an issue. 

Healthcare professionals screen and monitor all pregnant women during their prenatal appointments. Screening begins at your very first visit, and it continues throughout your pregnancy. Some of the screening tools and tests doctors use are: 

• Family history
• Health history
• Pregnancy history
• Physical examination 
• Measurements such as weight and blood pressure
• Ultrasound
• Blood and urine tests

If your medical history or any other screening results show that you may be more likely to face complications during your pregnancy, then your doctor will follow you and your pregnancy more closely.

Approximately 20 — 30 percent of pregnancies fall into the category of high risk. Your doctor may determine that you are high risk if you have a medical condition and become pregnant, or you develop a health issue once you are pregnant.

Your medical history, the state of your current pregnancy, and even your age can increase the chance of complications for you and the baby you're carrying. Here are some of the reasons your pregnancy may be high-risk.

Your age: Pregnancy is typically healthiest in your 20’s. But, you are more likely to encounter problems if you are:

• In your teenage years
• Over age 35 (advanced maternal age)

Your pregnancy history: Information about the pregnancies you’ve had before help your doctors decide if you need more monitoring or testing during this one. Previous pregnancy concerns include:

• Multiple miscarriages
• A long history of infertility
• Premature labor in a previous pregnancy
• Another pregnancy that ended in an early delivery
• A previous stillbirth or the loss of a newborn
• Other pregnancies that resulted in a c-section
• Five or more pregnancies

Your medical history: If you already have a known health condition before you become pregnant, doctors will follow you carefully to try to prevent it from getting worse or having an effect on your pregnancy. Health issues that can lead to pregnancy complications include:

• Fibroids in your uterus
• Previous surgery of your uterus
• Diabetes
• High blood pressure
• A heart condition
• Cancer
• Kidney disease
• HIV
• Obesity
• Autoimmune disorders

The state of your current pregnancy: Doctors will look at what’s going on with your present pregnancy to decide if you may be at risk for complications. You may be high-risk if:

• You are carrying more than one baby
• Your baby is not growing as expected
• Prenatal testing shows that your baby has a genetic concern or a health issue

You are experiencing pregnancy complications: Some health issues can begin during pregnancy. Your pregnancy can become high-risk if you develop:

• Gestational diabetes
• Preeclampsia
• Placenta previa
• Incompetent cervix
• An Rh incompatibility

The choices you make in your daily life: Your everyday life choices can have a big impact on your health and the health of your pregnancy. You are more likely to encounter complications during pregnancy if you:

• Drink alcohol
• Smoke cigarettes
• Use recreational drugs

When you have a high-risk pregnancy, you go to the doctor more often than if your pregnancy isn't considered high-risk. You may also see more doctors or a different type of doctor. Doctors who treat high-risk pregnancies include:

• Obstetrician (OB): Depending on your specific situation and where you live, your OB may take care of you throughout your high-risk pregnancy.
• Perinatologist: A perinatologist is an obstetrician who specializes in maternal-fetal medicine. They care for mothers and babies during high-risk pregnancies. You may meet with a perinatologist as part of your care and still see your OB, or your obstetrician may turn over your entire care to the perinatologist.
• Other doctors: Your OB or perinatologist may refer you to other doctors. You may see a cardiologist who can help keep your blood pressure under control or monitor a heart condition, or an endocrinologist to keep blood sugar in check or monitor a thyroid condition. You may also see doctors specializing in other areas of medicine depending on what you need. 

Since your doctor will follow and monitor you more closely during a high-risk pregnancy, there tends to be a lot of testing. You may have many of the following tests, some such as blood work or ultrasounds, quite often.

• Blood work for anemia (iron level), blood sugar, and infections such as HIV
• Urine tests to check for a urinary tract infection (UTI) or protein in the urine
• Weight and blood pressure monitoring
• Ultrasounds of your uterus, your cervix, and the baby
• A nuchal translucency (NT scan) of your baby’s neck at the end of the first trimester
• Fetal heart rate checks
• Fundal height measurements
• Genetic testing such as chorionic villus sampling (CVS), cordocentesis (umbilical cord blood sampling), or amniocentesis
• Glucose tolerance test (GTT)
• Alpha fetoprotein (AFP)
• Fetal echocardiogram
• Kick counts
• Swab for Group B strep
• Biophysical profile
• Non-stress test

There are things you should do to try to be as healthy as you can during any pregnancy, but it’s especially important during a high-risk pregnancy. If your pregnancy is high risk, here’s what you can do to manage it and stay as healthy as possible.

1. Prepare for pregnancy: Make an appointment with your OB/GYN when you begin thinking about starting your family, especially if you have a health condition such as diabetes or high blood pressure. Your doctor can gather information on your baseline health, advise you on how to stay healthy, and refer you to other doctors you may need to see depending on your individual needs.
2. Take folic acid: Folic acid helps prevent low birth weight and congenital disabilities such as spina bifida which can cause a high-risk pregnancy and life-long issues for your child. Folic acid may also help reduce the risk of other high-risk pregnancy conditions such as gestational hypertension, preeclampsia, and heart disease. The recommendation is 400 micrograms (0.4 mg) of folic acid each day for all women of childbearing age but especially for women who are or wish to become pregnant. If possible, start taking folic acid before you become pregnant and continue taking it throughout your entire pregnancy.
3. Go to all your doctor appointments: High-risk pregnancies require more monitoring, care, and treatment than a pregnancy that isn’t high risk. So, it might take up a lot of your time, and you may feel like you are always going to an office or a lab, but make it a point to get to all your prenatal testing and checkups. It's really important.
4. Nourish your body: Eat well and drink plenty of fluids. If you have special dietary needs because you're on a special diet, you have diabetes, or you have an eating disorder, then your doctor may recommend you see a nutritionist or a dietician be sure you're getting the proper nutrition you need during your pregnancy. You should also take your prenatal vitamins and any other vitamins, supplements, and medications that you need.
5. Make good decisions: Follow the advice and instructions of your doctor. Gain the appropriate amount of weight — not too little, not too much. If you smoke, try to quit and ask for help if you need it. Stay away from alcohol and recreational drugs. If you take prescription medication, use it the way your doctor directs you to use it, and make sure all of your doctors know that you are pregnant.

During any pregnancy, you should be on the lookout for signs that mean you need to seek medical care as soon as possible. It’s even more so when your pregnancy is high risk. So, be vigilant and watch out for:

• Bleeding
• A change in type or odor of vaginal discharge
• A gush of fluid
• Cramps
• Contractions
• A UTI — burning or pain when you pee
• A headache
• Blurry vision
• Feeling faint or very dizzy
• A fever
• A change in the baby’s movements 

If you feel that something is not quite right, contact your doctor or go straight to the hospital to get checked. It may not be anything. But, it’s better to go and find it’s nothing than to wait and wish you went after something goes wrong.

As mentioned earlier, a high-risk pregnancy can be uneventful, and most high-risk pregnancies end with a healthy baby. When you receive proper monitoring and treatment, follow your doctor’s advice, and do all you can to care for yourself and your body, you can lower the risk of complications.

With more and women becoming pregnant in their 30s, their age and the health conditions they bring with them increase the number of high-risk pregnancies. Many of these pregnancies are called high-risk but have only minor concerns.

However, sometimes a high-risk pregnancy can be more serious, or a low-risk pregnancy can develop an unexpected issue and become high-risk. When serious complications arise in pregnancy it can be dangerous for both mom and baby and lead to: 

• Preeclampsia/Eclampsia
• Premature labor
• Premature birth
• A small baby (IUGR)

Severe complications can even become life-threatening. Although it is rare in developed countries such as the United States, the complications of a high-risk pregnancy can lead to the death of a mother or baby. 

Learning that your pregnancy is high risk and getting through it can be stressful. Feelings of anxiety, sadness, and even anger are normal, but the constant worry throughout your pregnancy isn’t good for your health.

Your partner, family, and friends can be an excellent source of support. However, if you need someone else to talk to about your fears, you can reach out to your doctor or get a referral for a health professional who can help you work through your emotions. Once you feel more in control, you’ll be able to focus on staying healthy and enjoying your pregnancy.

Remember, just because your pregnancy is called high risk doesn’t mean that something terrible is going to happen. It just means that you need a little extra care and monitoring to keep you and your baby healthy. By going to all your appointments, following your doctor’s instructions and staying aware and informed of what to watch for you can get through it, keep the risks down, and do all you can to deliver a healthy baby.